A growing number of biological studies suggest that exogenous sulfur dioxide (SO 2 ) at a certain concentration may promote human resistance to Mycobacterium tuberculosis . However, the results of most relevant studies are inconsistent, and few studies have explored the relationship between SO 2 exposure and tuberculosis risk at provincial level. In addition, occupational exposure has long been considered to have a certain impact on the human body, so for the first time, we discussed the differences between different occupations in the study on the relationship between air pollutant exposure and tuberculosis risk, and evaluated the impact of occupational exposure. This study aimed to explore the association between short-term SO 2 exposure and the risk of outpatient visits to tuberculosis in Anhui province and 16 prefecture-level cities from 2015 to 2020. We used several models for multi-stage analysis, including distributed lag nonlinear model (DLNM), Poisson generalized linear regression model, and random-effects model. The association was assessed using the 28-day cumulative lag effect RR and 95%CI for each 10-unit increase in SO 2 concentration. We divided all patients into the following six occupations: Worker, Farmer, Retired people, Children and Students, Cadre and Office clerk, and Service staff (catering, business, etc.). Sex, age, and season were analyzed by subgroup. Finally, the robustness of the multi-pollutant model was tested. At provincial level, the overall effect value of SO 2 was RR=0.8191 (95%CI: 07702~0.8712); after grouping all patients by occupation, the association found only among Farmers (RR = 0.7150, 95%CI: 0.6699–0.7632, lag 0–28 days) and Workers (RR = 0.8566, 95%CI: 0.7930–0.9930, lag 0–4 days) was still statistically significant. Estimates for individual cities and using random-effects models to estimate average associations showed that SO 2 exposure was associated with a reduced risk of outpatient TB visits in 14 municipalities, which remained significant when aggregated (RR = 0.9030, 95%CI: 0.8730–0.9340). Analysis of patients grouped by occupation in each municipality showed that statistical significance was again observed only in the Farmer (RR = 0.8880, 95%CI: 0.8610–0.9160) and Worker (RR = 0.8250, 95%CI: 0.7290–0.9340) groups. Stratified analysis of age, sex, and season showed that the effect of SO 2 exposure was greater for middle-aged people (18–64 years old) and males, and less for seasonal changes. In summary, we found that exposure to SO 2 reduces the risk of outpatient visits to tuberculosis, with farmers and workers more susceptible to SO 2 . Gender and age had a greater impact on the risk of TB outpatient visits than seasonal variations. Supplementary Information The online version contains supplementary materi...
Some previous studies had linked air pollutants and greenness to the risk of death from tuberculosis (TB). Only a few studies had examined the effect of particulate matter (PM 2.5 ) on the mortality of TB, and few studies had assessed the impact and interaction of multiple air pollutants and greenness on the mortality of newly treated TB patients. The study included 29,519 newly treated TB patients from three cities in Anhui province. We collected meteorological data and five pollutants data from The National Meteorological Science Center and air quality monitoring stations. Greenness data were generated by remote sensing inversion of medium-resolution satellite images. We geocoded each patient based on the residential address to calculate the average exposure to air pollutants and the average greenness exposure for each patient during treatment. The Cox proportional risk regression model was used to evaluate the effects of air pollutants and greenness on mortality in newly treated tuberculosis patients. Our results found that the higher the concentration of air pollutants in the living environment of newly treated TB patients, the greater the risk of death: HR 1.135 (95% CI: 1.123–1.147) and HR 1.333 (95% CI: 1.296–1.370) per 10 μg/m 3 of PM 2.5 and SO 2 , respectively. Greenness reduced the mortality among newly treated TB patients: HR for NDVI exposure 0.936 (95% CI: 0.925–0.947), HR for NDVI_250m exposure 0.927 (95% CI: 0.916–0.938), and HR for NDVI_500m exposure 0.919 (95% CI: 0.908–0.931). Stratifying the cohort by median greenness exposure, HRs for air pollutants were lower in the high greenness exposure group. Mortality in newly treated TB patients is influenced by air pollutants and greenness. Higher green exposure can mitigate the effects of air pollution. Improving air quality may help reduce mortality among newly treated TB patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-022-24433-3.
Introduction Evidence has shown that air pollutant exposure plays a vital role in the progression of tuberculosis (TB). The aim of this research was to assess the short-term effects of ozone (O 3 ) exposure and TB outpatient visits in 16 prefecture-level cities of Anhui, China, 2015–2020. Methods Distributed lag nonlinear model (DLNM), Poisson generalized linear regression model and random effects model were applied in this study. The effects of different age and gender on TB were investigated by stratified analysis, and then we performed sensitivity analyses to verify the stability of the results. Results A total of 186,623 active TB cases were registered from January 1, 2015 to December 31,2020 in Anhui. The average concentration of ozone is 92.77 ± 42.95 μg/m 3 . The maximum lag-specific and cumulative relative risk (RR) of TB outpatient visits was 1.0240 (95% CI: 1.0170–1.0310, lag 28 days) for each 10 µg/m³ increase in O 3 in the single-pollutant model. Estimation for 16 prefecture-level cities indicated that the strong association between O 3 and the risk of TB outpatient visits was in tongling (RR = 1.0555, 95% CI: 1.0089–1.1042), Suzhou (RR = 1.0475, 95% CI: 1.0268–1.0687), wuhu (RR = 1.0358, 95% CI: 1.0023–1.0704). Stratified analysis showed that the health effects of ozone exposure remained significant in male and older adults, and there was no significant association between exposure to ozone in children and adolescents and the risk of tuberculosis. Discussion We found that ozone exposure increases the risk of TB infection in outpatient patients, with males and the elderly being more susceptible, and it is necessary for government departments to develop targeted publicity and prevention measures in response to the local air quality conditions.
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